Description of the Questionnaire

The Neonatal Facial Coding System (NFCS) is a unidimensional observational tool designed to measure pain in neonates. It is based on the observation of ten characteristic facial expressions associated with the presence of pain. Additionally, it includes seven supplementary items that assess alertness and sleep quality. There are two versions available: one for direct bedside observation and another for scoring through video analysis, specifically developed for scientific research.

Data Analysis and Use

Data is collected through systematic observation and recording of specific facial expressions. Recording can be done either in real time or through video analysis. The quantification of these expressions allows for the assessment of pain, and the data is mainly used for clinical evaluation and monitoring of the neonate’s condition, for research purposes related to neonatal pain, and for comparative analysis of the effectiveness of pain relief interventions.

Objective

The primary objective of the NFCS is the objective assessment of pain in neonates who are unable to verbally express their discomfort. The tool supports healthcare professionals in making informed decisions regarding the administration of analgesics or other therapeutic interventions, and contributes to the advancement of research in matters related to neonatal pain and well-being.

Scoring

Scoring is based on the presence or absence of specific facial expressions, such as brow bulge, eye squeeze, nasolabial furrow, open mouth, stretched mouth, vertical and horizontal tongue stretch, lip pursing, and chin quiver. Each characteristic is scored as either present or absent, and the sum of the values provides an overall assessment of pain intensity. The total score allows for the categorization of pain levels as mild, moderate, or severe.

Bibliography

Grunau R, et al. (1987). Neonatal Facial Coding System (NFCS). First version available on the ecmr website.